PLASMA PEN FORM ENGLISH

DECLARATION – EXPRESS CONSENT

Personal Data Processing Consent Form

I, , with telephone number , hereby declare that I give my free, specific, explicit, and fully informed consent to the Beauty Institute MACHI XINARY, located at 49 Prodromou Avenue, Strovolos 2063, Nicosia, to collect, store, and process personal data concerning me in accordance with the General Data Protection Regulation (EU) 2016/679 and the applicable national legislation, as amended from time to time.

I have also been informed that:

The Institute will collect, store, and process my personal data in either electronic or printed form, and may share and/or post related materials on public social media platforms for research, evaluation, informational, and/or advertising purposes.

This data may include my name, surname, and photographic material from services provided, which may be used to demonstrate the results of their work.

I confirm that I freely and with full understanding give my explicit consent to the lawful processing of my personal data for the purposes described above, in accordance with the relevant Personal Data Protection Laws, as amended.

Social Media Consent:

Do you agree to the posting of Before and After photos of your semi-permanent makeup application on social media, showing either your full face or only the eyebrow, lip, or eyeliner area?

Please select one:

Full faceEyebrow/eye/lip/eyeliner area

I solemnly declare that I accept the above.

Signature:

Date:

MEDICAL HISTORY – INDICATIVE INFORMATION

Please check the appropriate box with ✔:

Medical Condition
Diabetes	YES	NO
Hemophilia	YES	NO
Hepatitis A, B, C, D, E	YES	NO
HIV+	YES	NO
Autoimmune diseases	YES	NO
Skin conditions	YES	NO
Tendency to develop keloids	YES	NO
Epilepsy	YES	NO
Do you take any medication on a daily basis?	YES	NO
Do you suffer from any known allergies?	YES	NO
Have you recently undergone any other facial treatments?	YES	NO
Have you had Botox recently or plan to?	YES	NO
Are you currently pregnant?	YES	NO
Are you currently taking any antibiotics, antidepressants, or aspirin?	YES	NO
Do you have a history of previous semi-permanent makeup?	YES	NO

CLIENT CONSENT FORM:

1. I, ,give my full consent for the application of PLASMA PEN. I am aware that single-use materials will be used during the procedure.
2. I am aware that single-use materials will be used during the procedure. I release from any responsibility in case of allergic or other possible reactions to the applied products.
3. I confirm that I will receive instructions for after care. I agree to follow them and accept full responsibility for any issues that may arise due to failure to comply.

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